minutes
mm
How it's calculated
DTS = Exercise time (min) − (5 × ST-segment deviation in mm) − (4 × angina index)
Uses standard Bruce protocol exercise time. The angina index is 0 (none), 1 (non-limiting), or 2 (forces the test to stop).
Score interpretation
| DTS | Risk group |
|---|---|
| ≥5 | Low risk — excellent prognosis |
| -10 to +4 | Moderate risk |
| ≤-11 | High risk |
Clinical use
- Used to risk-stratify patients undergoing an exercise treadmill test for suspected or known coronary artery disease.
- Low-risk patients generally have an excellent prognosis and may not need further invasive testing; high-risk patients usually warrant further cardiac workup (e.g. angiography).
- Developed and validated specifically for the standard Bruce protocol — using a different protocol changes the exercise-time component and may affect accuracy.
Frequently asked questions
What is the Duke Treadmill Score used for?
It combines exercise time, ST-segment deviation, and exercise-induced angina from a treadmill stress test into a single score that risk-stratifies patients for coronary artery disease and prognosis.
What protocol is the Duke Treadmill Score validated for?
The standard Bruce protocol — the exercise-time component in the formula assumes this specific protocol's staged speed/incline increases.
What does a low DTS mean for further testing?
A low-risk score (≥5) is associated with an excellent prognosis and often means further invasive testing can be deferred, though this should always be interpreted alongside the full clinical picture.
References
- Mark DB, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325:849-853.